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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
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Elevations of diffusion anisotropy are associated with hyper-acute stroke: a serial imaging study.

Yusuf A Bhagat1, Muhammad S Hussain, Robert W Stobbe

  • 1Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta, Canada T6G 2V2.

Magnetic Resonance Imaging
|April 29, 2008
PubMed
Summary

Serial diffusion tensor imaging (DTI) in acute ischemic stroke reveals early, variable fractional anisotropy (FA) changes, followed by consistent reductions within 24 hours, clarifying diffusion anisotropy patterns.

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Area of Science:

  • Neuroimaging
  • Neurology
  • Medical Physics

Background:

  • Diffusion tensor imaging (DTI) studies in human ischemic stroke within 24 hours of symptom onset show inconsistent findings regarding diffusion anisotropy changes.
  • Serial DTI scans may help resolve these heterogeneous results by tracking longitudinal changes.
  • Understanding early diffusion changes is crucial for timely diagnosis and treatment of ischemic stroke.

Purpose of the Study:

  • To characterize longitudinal changes in diffusion anisotropy within specific white matter (WM) and gray matter (GM) regions during the hyperacute and acute phases of ischemic stroke.
  • To analyze diffusion parameters like mean diffusivity (MD) and fractional anisotropy (FA) in lesions and compare them to contralateral regions.

Main Methods:

  • Longitudinal DTI was performed on 13 ischemic stroke patients within 24 hours of symptom onset, including hyperacute (2.5-7 h) and acute (21.5-29 h) scanning phases.
  • Measurements of MD, FA, and T2-weighted signal intensity were taken in discrete deep/subcortical WM and deep/cortical GM regions within lesions defined by >30% MD decrease.
  • Relative changes in MD (rMD) and FA (rFA) were calculated by comparing lesion values to contralateral normal-appearing tissue.

Main Results:

  • Average reductions of approximately 40% in relative MD (rMD) were observed across all analyzed brain regions in both scanning phases.
  • In the hyperacute phase (< or =7 h), 9 of 13 patients showed elevated FA in at least one region, with significant rFA elevations noted in deep WM, subcortical WM, deep GM, and cortical GM in some patients.
  • By the acute phase (21.5-29 h), 11 of 13 patients exhibited reduced FA in at least one ischemic region, with more consistent rFA reductions observed (mean rFA = 0.85+/-0.12).

Conclusions:

  • Diffusion anisotropy in ischemic stroke lesions exhibits dynamic, heterogeneous changes in the early hours post-stroke, with initial elevations in FA followed by consistent reductions.
  • Serial DTI provides valuable insights into the temporal evolution of diffusion changes in both white and gray matter, aiding in the characterization of ischemic stroke.
  • These findings highlight the complex early microstructural alterations in brain tissue following ischemic events.